<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">

<html xmlns="http://www.w3.org/1999/xhtml"
      xmlns:wicket="http://wicket.sourceforge.net/">

    <body>
        <wicket:extend>
        
            <div class="row">
                <div class="col-lg-12">
                    <h1 class="page-header">Plata Anticipata pentru <span wicket:id="codTaraba"></span></h1>
                </div>
                <!-- /.col-lg-12 -->
            </div>
            <!-- /.row -->

            <div class="row">
                <div class="col-lg-6">
                    <div class="panel panel-default">
                        <div class="panel-heading">
                            Configurare Plata Anticipata noua
                        </div>
                        <!-- .panel-heading -->
                        
                        <span wicket:id="feedback"></span>
                        
                        <div class="panel-body">
                            <div class="panel-group" id="accordion">
                                <div class="panel panel-default">
                                    <div class="panel-heading">
                                        <h4 class="panel-title">
                                            <a data-toggle="collapse" data-parent="#accordion" href="#collapseOne">Client existent:</a>
                                        </h4>
                                    </div>
                                    <div id="collapseOne" class="panel-collapse collapse in">
                                        <div class="panel-body">
                                            
                                            <form role="form" wicket:id="form1">
                                                
                                                    <div class="form-group">
                                                        <label>Taxa</label>
                                                        <select class="form-control" wicket:id="taxa1"></select>
                                                    </div>
                                                    <div class="form-group">
                                                        <label>Valoare</label>
                                                        <input class="form-control" id="disabledInput" type="text" placeholder="700" disabled wicket:id="valoare">
                                                    </div>
                                                    
                                                    <div class="form-group">
                                                        <label>Client</label>
                                                        <select class="form-control" wicket:id="firma1"></select>
                                                    </div>
                                                    
                                                    <div class="form-group">
                                                        <label>Data plata</label>
                                                        <input type="text" class="form-control input-sm" wicket:id="dataPlata" />
                                                    </div>
                                                    <div class="form-group">
                                                        <label>Data Start Perioada</label>
                                                        <input type="text" class="form-control input-sm" wicket:id="dataStart" />
                                                    </div>
                                                    <div class="form-group">
                                                        <label>Data Stop Perioada</label>
                                                        <input type="text" class="form-control input-sm" wicket:id="dataStop" />
                                                    </div>
                                                    
                                                    <button type="submit" class="btn btn-primary" wicket:id="submit1">Salveaza</button>
                                                    <button type="reset" class="btn btn-default" wicket:id="quit">Renuntare</button>
                                            </form>

                                        </div>
                                    </div>
                                </div>
                                
                                <div class="panel panel-default">
                                    <div class="panel-heading">
                                        <h4 class="panel-title">
                                            <a data-toggle="collapse" data-parent="#accordion" href="#collapseTwo">Client nou:</a>
                                        </h4>
                                    </div>
                                    <div id="collapseTwo" class="panel-collapse collapse">
                                        <div class="panel-body">
                                            <form role="form" wicket:id="form">
                                            
                                                <div class="form-group">
                                                    <label>Denumire</label>
                                                    <input class="form-control" wicket:id="denumire">
                                                </div>
                                                <div class="form-group">
                                                    <label>CIF / CUI / CNP</label>
                                                    <input class="form-control" wicket:id="cif">
                                                </div>
                                                <div class="form-group">
                                                    <label>Adresa</label>
                                                    <textarea class="form-control" wicket:id="sediuSocial"></textarea>
                                                </div>
                                                <div class="form-group">
                                                    <label>Date contact</label>
                                                    <input class="form-control" wicket:id="dateContact">
                                                </div>

                                                <button type="submit" class="btn btn-default" wicket:id="submit">Salveaza</button>
                                                <button type="reset" class="btn btn-default" wicket:id="renuntare">Renuntare</button>

                                            </form>
                                        </div>
                                    </div>
                                </div>

                            </div>
                        </div>
                        <!-- .panel-body -->
                    </div>
                    <!-- /.panel -->
                </div>
                <!-- /.col-lg-12 -->
            </div>
            <!-- /.row -->
            
            <!-- Core Scripts - Include with every page -->
            <script src="js/jquery-1.10.2.js"></script>
            <script src="js/bootstrap.min.js"></script>
            <script src="js/plugins/metisMenu/jquery.metisMenu.js"></script>
            <!-- SB Admin Scripts - Include with every page -->
            <script src="js/sb-admin.js"></script>
            
        </wicket:extend>
    </body>
</html>